Flashcards in Behav. Sci. Insomnia Deck (21):
complaint of dissatisfaction with sleep quantity or quality, associated with:
-difficulty initiating, maintaining, or early morning awakening with inability to return to sleep
-at least 3 nights per week in the last 3 months
sleep disorder characterized by problems in timing, quality, or amount of sleep (insomnia is classified as this)
sleep disorder characterized by abnormalities in physiology or behavior associated with sleep
epidemiology of insomnia
1/3 of adults, 10-15 with impairments, women more often, increases with age
etiology of insomnia
-excitatory neurotransmitters in excess at night (NE, serotonin, dopamine, histamine)
-inhibitory neurotransmitter deficiency at night (loss of GABA, melatonergic, adenosinergic)
-use of CNS stimulants (caffeine)
-withdrawal of sedating agents (alcohol, barbiturates, benzos)
-medical conditions (pain, pulmonary disease, endocrine disorders)
-psychiatric causes (MDD, bipolar, generalized anxiety/PTSD)
where does NE come from?
where does serotonin come from?
where does dopamine come from?
ventral tegmental area
where does histamine come from?
which symptoms commonly lead to insomnia?
anxiety (getting caught up in thoughts about past events, excessive worrying, overwhelmed) also anxiety about not falling asleep
effects of insomnia
decreased quality of life, complaints of impaired daytime performance, self-medication, risk of psychiatric disorder
management of insomnia step 1
diagnosis, informed consent and education
management of insomnia step 2
behavioral counseling (sleep hygiene/stimulus control)
"ten basic rules for a good night's sleep" (regular sleep schedule, 20 min exercise in morning, avoid smoking and alcohol, adjust bedroom environ, etc)
management of insomnia step 3
sleep restriction therapy, cognitive therapy (talking through and imagery), behavioral therapy (diary/log book, progressive relaxation, self hypnosis)
management of insomnia step 4
1. OTC: melatonin, antihistamines
2. Rx agents/nonhabit forming (antihistamines, melatonin1+2 agonists (ramelteon, tasimeltean)
3. Rx agnets/mild-habit forming (benzodiazepine, receptor agonists (zolpidem, zaleplon, ezopiclone, orexin 1+2 antagonists, suvorexant)
4. Rx agents/habit forming (benzodiazepines (triazolam, temazepam, flurazepam) and off label options
pharmacokinetics of sleeping pills:
faster absorbed = ?
shorter half life = ?
longer half life = ?
faster absorbed allows = faster absorbed allows faster sleep onset
shorter half life allows = the drug to leave your system by the morning but risks less hours of sleep
longer half life allows = longer sleep, but greater chance of being under the influence in the morning
what do patients with restless legs get to treat insomnia?
which patients cannot get sedatives?
antagonizing what creates deeper sleep patterns?